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. 2022 Aug;76(2):469-482.
doi: 10.1002/hep.32294. Epub 2022 Jan 24.

Angiotensin-converting enzyme inhibitors prevent liver-related events in nonalcoholic fatty liver disease

Xinrong Zhang  1   2   3 , Grace Lai-Hung Wong  1   2   3 , Terry Cheuk-Fung Yip  1   2   3 , Yee-Kit Tse  1   2   3 , Lilian Yan Liang  1   2   3 , Vicki Wing-Ki Hui  1   2   3 , Huapeng Lin  1   2   3 , Guan-Lin Li  1   2   3 , Jimmy Che-To Lai  1   2   3 , Henry Lik-Yuen Chan  2   4 , Vincent Wai-Sun Wong  1   2   3
Affiliations

Angiotensin-converting enzyme inhibitors prevent liver-related events in nonalcoholic fatty liver disease

Xinrong Zhang et al. Hepatology. 2022 Aug.

Abstract

Background and aims: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can inhibit liver fibrogenesis in animal models. We aimed to evaluate the impact of ACEI/ARB use on the risk of liver cancer and cirrhosis complications in patients with NAFLD.

Approach and results: We conducted a retrospective, territory-wide cohort study of adult patients with NAFLD diagnosed between January 2000 and December 2014 to allow for at least 5 years of follow-up. ACEI or ARB users were defined as patients who had received ACEI or ARB treatment for at least 6 months. The primary endpoint was liver-related events (LREs), defined as a composite endpoint of liver cancer and cirrhosis complications. We analyzed data from 12,327 NAFLD patients (mean age, 54.2 ± 14.7 years; 6163 men [50.0%]); 6805 received ACEIs, and 2877 received ARBs. After propensity score weighting, ACEI treatment was associated with a lower risk of LREs (weighted subdistribution hazard ratio [SHR], 0.48; 95% CI, 0.35-0.66; p < 0.001), liver cancer (weighted SHR, 0.46; 95% CI, 0.28-0.75; p = 0.002), and cirrhosis complications (weighted SHR, 0.42; 95% CI, 0.27-0.66; p < 0.001), but ARB was not. In subgroup analysis, ACEI treatment was associated with greater reduction in LREs in patients with chronic kidney diseases (CKDs) than those without (CKD-weighted SHR, 0.74; 95% CI, 0.52-0.96; p = 0.036; non-CKD-weighted SHR, 0.15; 95% CI, 0.07-0.33; p < 0.001).

Conclusions: ACEI, rather than ARB, treatment is associated with a lower risk of LREs in NAFLD patients, especially among those with CKD.

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